How to Decide What Antidepressant to Take

What to Discuss With Your Doctor When Deciding

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There are more than 20 medications that are approved by the FDA for the treatment of depression. All of these medications have unique side effects and may work differently in different people. So it's important to have a conversation with your doctor about which one to try and why.

Keep in mind that you may have to give the medication some time—likely a few weeks—to feel its effects and you might have to try a few different types or a few different combinations before finding the best fit.

How to Choose the Right Antidepressant for You

If you have been diagnosed with depression and need to take medication, you and your doctor will need to choose an appropriate antidepressant.

Consider the following issues when choosing an antidepressant:

Safety Considerations

  • Do you have other health conditions besides depression? Your doctor will think about all of your health issues and will avoid giving you an antidepressant that could have a negative effect on any of your other health conditions. For instance, tricyclic antidepressants like Elavil (amitriptyline), Sinequan (doxepin), and Tofranil (imipramine) are usually not given to people who have certain cardiovascular conditions, such as an irregular heartbeat or low blood pressure.
  • What other meds are you taking? Antidepressant medications may interact with other medications that you are taking. Before prescribing a medication to treat your depression, your doctor will consider which antidepressant will work well with your other medications. For example, some people who experience migraine headaches take a medication that's known as a triptan—such as Imitrex (sumatriptan), Maxalt (rizatriptan), Relpax (eletriptan), and Zomig (zolmitriptan). These particular drugs can cause a very rare but serious side effect called serotonin syndrome if they're taken with a SSRI. So a doctor may prefer to give you a non-SSRI medication to treat your depression.
  • Has your doctor prescribed the drug before? Your doctor may want to choose an antidepressant that he or she has had experience prescribing. That way, your doctor will be very familiar with the medication’s side effects and the possibility of any drug interactions.

Targeting Specific Symptoms and Avoiding Side Effects

  • Are you male or female? If you're male and you're sexually active, your doctor may avoid prescribing you selective serotonin reuptake inhibitors (SSRIs) like Paxil (paroxetine) or Zoloft (sertraline) because they may cause erectile dysfunction. Other options such as Wellbutrin (bupropion) are less likely to have this side effect and could be used instead of an SSRI.
  • What are your depression-related symptoms? For instance, if you have anxiety along with your depression that's causing insomnia, your doctor might recommend a drug like Remeron (mirtazapine) that has a sedating effect at bedtime. Or if you commonly experience fatigue, your doctor might suggest taking Wellbutrin (bupropion), which can help you become more active. 

What Is Likely to Work Best for You

  • Do you have a past history of depression? If you do and you've used an antidepressant in the past that has worked well, your doctor will most likely prescribe the same medication for you to use again.
  • Does depression run in your family? If any immediate members of your family (such as your parents, brothers, or sisters) have been treated for depression with a medication that worked well for them, your doctor may suggest that you also try that medication for your depression.
  • Do you often forget to take pills? If taking a drug properly is challenging for you, your doctor might want to prescribe a longer-acting antidepressant such as Wellbutrin XL (bupropion) or Paxil CR (paroxetine), so you don't have to remember to take a pill as often.
  • How much can you afford to spend on treatment? Some medications that are used to treat depression are expensive. Your doctor will work with you to choose an antidepressant that you can afford. Many of the commonly used antidepressants are available in a generic version, and generic versions tend to be cheaper. Your doctor may also suggest shopping around different drugstores and calling your insurance company to find the best price available.

    What to Expect When Starting an Antidepressant

    Many medications that are used to treat depression take time to work and your depression symptoms may start to get better within one to three weeks of using your antidepressant medicine. However, it can take as long as six to eight weeks to see improvement.

    If the medication is not working, your doctor may want to increase the dose or have you switch to a different antidepressant. Your doctor may also suggest trying counseling or psychotherapy either instead of or in addition to the medication.

    After starting your antidepressant, you may experience side effects. Many of these side effects are temporary and go away with your continued use of the medication, although some side effects—such as constipation and sexual problems—may persist.

    What to Do If You Have Questions or Problems With Your Medication

    Talk to your doctor if you have questions or concerns about your medications, including how well the medication is working and whether you have any side effects.

    Depression Discussion Guide

    Get our printable guide to help you ask the right questions at your next doctor's appointment.

    Mind Doc Guide

    Also, do not stop taking your antidepressant medication without talking with your doctor first. Stopping your antidepressant medications abruptly could cause harmful effects or the symptoms of your depression may return.

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